The Three-Month Wound Complication and Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage for Infection Prophylaxis in High-Risk Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial

Abstract

Background: Periprosthetic joint infection (PJI) is a high-cost and extremely morbid complication following total joint arthroplasty; thus, developing a better understanding of perioperative infection prevention strategies is prudent. Literature is mixed regarding the efficacy of vancomycin powder and dilute povidone-iodine lavage, and limited on the combination thereof. To our knowledge, no prospective orthopedic clinical trials to date have evaluated the efficacy of local vancomycin powder, dilute povidone-iodine lavage, or a combination vancomycin-povidone-iodine protocol against normal saline irrigation.

Methods: In a large, prospective, multicenter, randomized-controlled study, four distinct infection prevention strategies were implemented in high-risk total joint arthroplasty patients. Local vancomycin powder, dilute povidone-iodine solution, combined vancomycin-povidone-iodine protocol, and saline control were used. Primary outcomes included PJI, wound complications, revisions, emergency department visits, readmissions, and serious adverse events within 3 months of index surgery. Chi-square tests were used to compare incidence rates. The criteria used for the diagnosis of PJI were the International Consensus Meeting guidelines.

Results: There were 821 total hip arthroplasty (THA) and 1,080 total knee arthroplasty (TKA) patients randomized into well-balanced study groups. In the THA and TKA cohorts, respectively, there were no statistically significant differences in rates of persistent wound drainage or dehiscence (P = 0.98, P = 0.95), cellulitis or abscess (P = 0.81, P = 0.51), 3-month infection rates (P = 0.14, P = 0.13), type of septic revisions performed (P = 0.51, P = 0.80), aseptic revision rates (P = 0.07, P = 0.90), emergency department visits (P = 0.61, P = 0.46), or readmissions (P = 0.78, P = 0.87) between the four treatment groups.

Conclusions: There were no statistically significant differences in PJI or other surgical outcomes following THA or TKA among the study groups. Therefore, the use of such prophylactic measures, including povidone-iodine and vancomycin powder in high-risk patients, can be left up to the surgeon or hospital discretion.

Keywords: PJI; infection prophylaxis; periprosthetic joint infection; povidone iodine; saline lavage; vancomycin powder.